RELEASE: Multiple updated CACFP Forms

" August 1, 2022 - TDA has revised multiple forms on the CACFP Administration/Forms page on
August 1, 2022 - The following CACFP-related forms have been revised to update the Nondiscrimination Statement (NDS) as implemented by USDA:

      • CACFP Meal Benefit Income Eligibility Form (Adult Care)
      • CACFP Meal Benefit Income Eligibility Form (Adult Care) – Spanish
      • CACFP Meal Benefit Income Eligibility Form (Child Care)
      • CACFP Meal Benefit Income Eligibility Form (Child Care) – Spanish
      • H1663 - Letter of Determination - Pricing Programs (Adult Day Care)
      • H1659 - Notice to Providers of Tier Determination (Child and Adult Care Food Program-Day Care Homes)

A new 2022-2023 WIC Information Flyer - English and Spanish has also been posted.

Finally, an updated CACFP Form H1625-A - 2023 Income Eligibility Guidelines for Determining Free and Reduced Price Benefits was updated and re-posted on SquareMeals. The update was to fix a typographical error. The previous version listed $2,906 as the monthly income threshold for reduced-price meal eligibility for a household size of 1. The form has been updated to reflect the correct $2,096 amount.

All forms can be found in the Forms tables at:;Forms.aspx


Assistance available in English and Spanish. Please call 877-TEX-MEAL (877-839-6325) for help.

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity.

Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at:, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:

1. Mail:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; or
2. Fax: (833) 256-1665 or (202) 690-7442; or
This institution is an equal opportunity provider. Logo

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